Our Consortium of four hospital providers and three payer organizations is having trouble with the interpretation of a couple of things in the IG
1.) The DTP segment in the 276 (pg. 86) as well as the front matter of the guide (pg. 36) indicates that the date in the inquiry is the date that was originally indicated on the claim that was billed by the provider. This seems to be a bit of a restriction of functionality, since it would be more useful if you could inquire about a range of dates and be able to receive all claims that had dates of service within that range. Any thoughts? 2.) The other issue is the subscriber/dependent loop issue. The question is whether it is acceptable to build inquiries (and/or claims for that matter) at a subscriber level even if you don't know if the patient truly is the subscriber or not? All responses welcome, as we are at quite an impasse. Thank you. Jon Fox CONFIDENTIALITY NOTICE. This e-mail and attachments, if any, may contain confidential information which is privileged and protected from disclosure by Federal and State confidentiality laws, rules or regulations. This e-mail and attachments, if any, are intended for the designated addressee only . If you are not the designated addressee, you are hereby notified that any disclosure, copying, or distribution of this e-mail and its attachments, if any, may be unlawful and may subject you to legal consequences. If you have received this e-mail and attachments in error, please contact Independent Health immediately at (716) 631-3001 and delete the e-mail and its attachments from your computer. Thank you for your attention.
